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Achalasia

Achalasia Anatomy

The esophagus is the tube that carries food from your mouth to your stomach. A muscular ring located where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. This allows food to move down the esophagus. In people with achalasia, this muscular ring or sphincter does not relax properly. Swallowing is difficult because achalasia affects the ability of the esophagus to move food toward your stomach.

Causes & Risk Factors

Achalasia is a rare disorder caused by damage to the nerves of the esophagus. The disorder may occur at any age, but is most common in middle-aged or older adults; it may also be inherited in some people.

Symptoms

Achalasia can cause symptoms similar to cancer of the esophagus and upper stomach, as well as a parasitic infection known as Chagas disease. Achalasia symptoms may include:

  • Backflow (regurgitation) of food
  • Chest pain that may increase after eating
  • Chest pain also felt in the back, neck, and arms
  • Cough
  • Difficulty swallowing liquids and solids
  • Heartburn
  • Unintentional weight loss

Treatment

Your doctor can help you to decide which treatment is best for your situation. The goal of treatment is to reduce the pressure at the lower esophageal sphincter. Treatment may consist of one or more of the following:1

Botulinum (Botox) Injection

Botox is injected directly into the esophageal sphincter and may help relax the sphincter muscles. Any benefit wears off within weeks or months and the injections must be repeated. This treatment is usually reserved for elderly patients or those at high surgical risk. Botox was developed from the toxin causing botulism, a form of food poisoning. However, botulism is not a concern with very low doses used as treatment for achalasia. No one has ever developed botulism from this treatment.1

Medications

There are several medications for early stage achalasia, such as long-acting nitrates or calcium channel blockers, used to relax the lower esophagus sphincter. The treatment is considered temporary and may cause certain side effects such as low blood pressure and swollen feet which you should discuss with your doctor.

Pneumatic (Balloon) Dilation

This procedure dilates the esophagus at the location of the narrowing. A balloon is inserted into the esophagus to stretch the sphincter (local anesthetic is used to numb the throat). This procedure is successful 50 to 80 percent of the time and does not require hospitalization. If balloon dilatation is successful, its benefits are usually permanent. However, a small number of people may need repeat treatment if the esophageal sphincter contracts. There is also a risk (4 to 5 percent) of esophageal tearing during the procedure. If a tear occurs, emergency surgery is performed to repair the tear.

Surgery

Your doctor may recommend surgery to treat achalasia. Achalasia surgery is called esophagomyotomy or heller myotomy.

Open Surgery

With traditional open surgery for achalasia, surgeons must make a large incision into the chest or abdomen to cut the sphincter muscle. Open surgery may require up to one week in the hospital and a lengthy recovery.

Traditional Laparoscopy

Surgery for achalasia is most often done using laparoscopic (minimally invasive) surgery through a few small incisions. Surgery can last about two hours. Prior to the esophageal sphincter muscle being cut, special surgical instruments and a tiny camera are inserted through the abdominal incisions. The camera sends images to a video monitor in the operating room to guide surgeons as they operate. One to two days in the hospital is usually required.

If the surgery is successful, the benefits are usually permanent. However, a small number of people may need repeat treatment if the esophageal sphincter contracts or tears. An additional procedure to wrap the upper stomach around the lower esophagus (nissen fundoplication) to prevent reflux of stomach content into the esophagus is sometimes done at the same time that the esophageal sphincter muscle is cut.

da Vinci Heller Myotomy Surgery

If your doctor recommends surgery for achalasia, you may be a candidate for minimally invasive da Vinci Surgery. da Vinci surgeons make just a few small incisions - similar to traditional laparoscopy. However, the da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your surgeon to operate with enhanced vision, precision, dexterity and control.

State-of-the-art da Vinci uses the latest in surgical and robotics technologies and is beneficial for performing complex surgery. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. da Vinci – taking surgery beyond the limits of the human hand.


  1. "Achalasia", National Institutes of Health, www.nlm.nih.gov, URL: http://www.nlm.nih.gov/medlineplus/ency/article/000267.htm

All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risk specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to an open approach; or the need for additional or larger incision sites. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/da-vinci-surgery/safety-information.php.

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